1. Building Effective Partnerships to End Childhood Obesity Stephen Cook, MD, MPH, Golisano Children’s Hospital at URMC

2. Disclosures Grant funding: NYS Dept of Health, Children’s Institute, NIH CBPR project Boards: ABOM, AAP IHCW..…and I used to work at a TJ’s Big Boy

3. Host a Community Screening

4. Declining childhood obesity rates — where are we seeing the most progress? 4 DISPARITIES PERSIST To date, only Philadelphia has reported major progress in closing the disparities gap.

5. Stigma of Childhood Obesity “The lot of fat children is a sad one. They are bashful and ashamed of their shapeless figures, yet unable to conceal them. Wherever they go they attract attention…..Obesity is a serious handicap in the social life of a child, even more so of a teenager. Obesity does not have the dignity of other diseases…” 5 Bruch H. Pediatric Annals: 1975

6. Adolescents’ Perceptions of Peers Being Teased or Bullied: The Reason Why 6 Perceptions of weight-based victimization among N=1555 high school students in Connecticut

7. Percentage of teen girls who report frequent weight teasing 7 Neumark-Sztainer. J Adolesc Health. 2009;44:206-213.

8. Obesity Algorithm 1)Example – medical risk or behavioral risk 2)10 years and older every 2 years 3)Progress to next stage if no improvement in BMI/weight after 3-6 months and family willing 4)Age 6-11yr = 1 lb/month, Age 12-18yr = 2 lbs/week average 5)Age 2-5yr = 1 lb/month, Age 6-18yr = 2 lbs/week average

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10. 10 Children and Adolescents age 2 to 18 years of age

11. In Our Backyard 11

12. 12 Health Foundation Healthy Weight Strategy GOAL: Reduce the prevalence of overweight and obesity from 15% to 5% of Monroe County children ages 2-10 by 2017 [from 12,144 kids to 4,081 kids] GOAL: Reduce the prevalence of overweight and obesity from 15% to 5% of Monroe County children ages 2-10 by 2017 [from 12,144 kids to 4,081 kids] Increase physical activity and improve nutrition Engage the clinical community Advance policy and practice solutions Execute a community communications campaign

13. Evidence-based Behavioral Strategies Breastfeed Limit sugar-sweetened beverages Consume the recommended fruits and vegetables Eat daily breakfast Limit fast food Use appropriate portion size Eat meals together as a family Limit television and screen time and keep televisions out of children’s bedrooms Encourage moderately vigorous physical activity of 60 min/day or more Ensure adequate sleep; 1-3yr: 12hr, 3-5yr: 11hr, 5-12: 10hr and try to get teens after 8.5 hrs of sleep at night 13

14. Parents estimation of child’s weight status vs. measured weight, 2-9yo 14 Estimation of weight 193 parent/child dyads from Strong Pediatrics Tschamler, et al, Clin Peds, 2010;49:470

15. GROC Breakthrough Series (12 Months) Select Topic Planning Group Develop Framework & Changes Participants Pre-work LS 1 P S AD P S AD LS 3 LS 2 Expert Meeting Stages of Improvement -test -implement -hold the gain -spread Beyond LS 3 How well do successful teams “hold the gains” after LS3? Supports -Emails -Office Visits -Phone Conferences -Monthly Team Reports -Assessments Borrowed from IHI

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19. 19 Some Results from Our Practices

20. 20 OBESITY CHRONIC CARE MODEL Self Management Support Decision Support Delivery System Design Clinical Information Systems  Emphasize the patient’s central role  Organize resources to provide support  Use effective self- management strategies that include assessment, goal setting, action planning, problem solving, & follow up  Embed evidence- based guidelines into daily clinical practice  Integrate specialist expertise and primary care  Use proven provider education methods  Share guidelines and information with patients  Define roles and distribute tasks among team members  Use planned interactions to support evidence- based care  Provide clinical case management service for high risk patients  Ensure regular follow-up  Give care that patients understand and that fits their culture  Provide reminders for providers and patients  Identify relevant patient sub- populations for proactive care  Facilitate individual patient care planning  Share information with providers and patients  Monitor performance of team and system

21. Healthy Weight BMI 5 - 84%ile Overweight BMI 85 - 95%ile Obese BMI 95 - 98%ile BMI >=99%ile Primary Care Setting ?

22. 22 3yr old WCC w/ pt Not Mykid

23. 23 Pt NW, first seen at 3yrs and noted to be obese PNP informed pt in ‘Red zone’ as unhealthy. Can we discuss?

24. 24 Pt MN

25. Dr. Colpoys at Genesee Pediatrics

26. Penfield Pediatrics

27. Unity Pediatrics

28. More Unity Pediatric Pics

29. 29 Monroe County, NY – Estimated Birth Cohort = 1,015 Cycle 3 56.0% n= 26 Cycle 2 46.3% (n = 17) Extent of Community Reach Cycle 1 24.8% n=9

30. 30 OBESITY CHRONIC CARE MODEL Community Resources and PoliciesHealth Care Organization  Encourage patients to participate in effective programs  Form partnerships with community organizations to support or develop programs  Advocate for policies to improve care  Visibly support improvement at all levels, starting with senior leaders  Provide incentives based on quality of care  Promote effective improvement strategies aimed at comprehensive system change  Encourage open and systematic handling of problems  Development of agreements for care coordination

31. 31 Results Monroe County, NY 5.0% - 10.0% 10.1% - 15.0% 15.1% - 20.0% 20.1% - 24.0% Obesity by Neighborhood Healthy Food Source Unhealthy Food Source RFEI =

32. Maps of Parks and Recreation Centers 32

33. Rec on the Move 33

34. “Rec on the Move” comes to the Doc Office 34

35. Foodlink Curbside Market 35

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37. Additional Partners / Tools 37

38. Pediatric e-Practice: Optimizing Your Obesity Care

39. Healthy Active Living for Families

40. Structured Weight Management AAP & Academy of Nutrition and Dietetics (former ADA): Set of visits with PCP and RD Based on motivation at start Self monitoring and uses tracking forms

41. One City’s “Communities of Solution” 41 Note: Political boundaries, shown in solid lines, often bear little relation to a community’s problem-sheds or its medical trade area. Adopted from Folsom M. Health is a Community Affair: Report of the National Commission on Community Health Service, 1967

42. Next steps Pediatric Primary Care Practices and using EMR Writing reports for data collection CDC piloting EMR templates for surveillance Linking Resources in Community with Patient Centered Medical Home STRONG Pediatrics has medical home designation RGH completing pediatric medical home Highland FM and Anthony Jordan Create Linkage and Test Stage 2: Structured Weight Managment STOP Obesity Alliance: Community Health Benefit Children’s Hospital Association: Focus on a Fitter Future / Stage 3:CMWM 42

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45. Thank you Department of Pediatrics, GCH@URMC